In-Person and Telehealth Behavioral Skills Training to Reduce Child Restraint System Misuse

ABSTRACT

One of the leading causes of hospitalizations and fatalities for children in the United States is motor vehicle occupant injury. Risks are reduced when child restraint systems are properly used. However, child restraint system misuse is a continuing public health problem. A longitudinal quasi-experimental within-subjects group design was used across two experiments that recruited 2,448 paired participants to educate proper use of their child restraint system. Experiment one participants were randomly assigned to a behavior skills training or traditional training group. Results demonstrated that behavioral skills training participants reduced misuse more effectively than traditional training. Experiment two participants were assigned to a behavioral skills training in-person or virtual telehealth group. Results confirmed both groups were equally as effective in reducing misuse. A 9-month evaluation validated long-term maintenance of behavioral skills training to reduce misuse. This study demonstrates a method to improve certified child passenger safety training programs to reduce misuse.

KEYWORDS:

• Behavioral skills training
• car seat
• child restraint system
• misuse
• motor vehicle injury
• telehealth

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. Traditional CRS education is the National Highway Traffic Safety Administration (NHTSA), National Child Passenger Safety Certification Training Program (CPS certification program) that certifies child passenger safety technicians and instructors provided by Safe Kids Worldwide.

2. The use of dolls or stuffed animals to represent children while learning to restrain a child in a CRS is common in the National Child Passenger Safety Technician Certification Training. While the size and shape of a doll or stuffed animal may vary, it is up to the CPST to model to the parent/caregiver how to adjust the CRS harness to fit correctly.

3. Focus groups are controlled interviews that include a select group of 5–12 individuals who have similar characteristics and are stakeholders (i.e., expectant women) of a specific topic of discussion (i.e., car seats, etc.).

4. Cognitive interviewing (CI) is a process led by a facilitator with one individual at a time to pretest written material and receive feedback that can be incorporated into final written material that is more understandable. For the purpose of this study, the CI presented individual participants with child restraint system and motor vehicle occupant protection terminology, and related educational materials, to ensure they understand the material in the way it was intended. Modifications were applied depending on the feedback of each individual.

5. WhatsApp is a commonly used, no cost, cross platform messaging and video calling app that uses mobile data or Wi-Fi.

Additional information

Funding

This study was registered with ClinicalTrials.gov (Identifier: NCT05490992).This research was established as a cognitive-based study to assess the efficacy of child passenger educational approaches to reduce misuse as part of the Occupant Protection section of the 2014–2019 and 2020–2024 State of California, Strategic Highway Safety Plan.